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132 thoughts on “H1N1 Update

  1. wales says:

    I read Dr. Crislip’s article last week, as you can see from my comments there. I looked at the Ontario study and realized that it did not include vaccination rate data for those under 12 years of age or the institutionalized elderly. There are other drawbacks as well. That doesn’t mean the study should be dismissed out of hand, of course. But especially regarding children <12 and the institutionalized elderly, both populations most likely to experience disease complications and mortality and both populations exhibiting lower vaccine efficacy in the Cochrane systematic reviews, we can draw no conclusions. I’ll take another look.

  2. wales says:

    btw cheglabratjoe, please point out my misuse of latin terms.

  3. cheglabratjoe says:

    Lotta persecution complexes on SBM today!

    An ad hominem argument is the following: “statement X is wrong because person Y said it, and that person has bad characteristic Z.” That’s it! The following things are not ad hominems: insults, name-calling, and swearing. Real ad hominems are rare, because they sound ridiculous and even discriminatory.

    This would be an ad hominem: “what Jefferson said was wrong because he is anti-vaccine.” No one said that. The closest anyone came to that was Gorski saying he was suspicious of Jefferson’s intent because of the Atlantic article and his acceptance of the invitation to speak at an antivax event. That isn’t an ad-hom, and moreover it’s prudent. I’d be suspicious of someone’s knowledge of evolution if they spoke at an intelligent design event, or of their thermodynamics if they spoke at a perpetual motion event. So what?

  4. wales says:

    Webster’s ad hominem definition:

    1: appealing to feelings or prejudices rather than intellect
    2 : marked by or being an attack on an opponent’s character rather than by an answer to the contentions made

    I believe Dr. Hall characterized Gorski’s comments on Jefferson as ad hominem as well.

    No matter.

  5. Dr Benway says:

    Wales, quoting the dictionary is rather weak.

    Surely a smart person like yourself can recognize the difference between an ad hominem, which is a logical fallacy, and an insult, which is an expression of personal feeling.

  6. Todd W. says:

    @wales

    cheglabratjoe had the definition of an ad hominem, at least according to several different sites on logical fallacies. It is saying the the person is wrong because of some characteristic about the person, rather than some characteristic of the argument being made. E.g., “You clearly could not be right about vaccines because you make money from pharma companies.” or “You’re a religious wing-nut, therefore your argument about evolution must be wrong.”

    It’s not merely an appeal to emotions or attacking the person (e.g., “You’re an idiot”). The former is a different logical fallacy and the latter may simply be an insult, but not necessarily a logical fallacy.

    At least, that’s what I gathered from reading about ad homs at a few different sites.

  7. wales says:

    Yeah right, quoting the dictionary is weak. At least it prevents me from indulging in deranged splenetic outbursts.

  8. wales says:

    btw, quibbling about semantics is just another distraction from the topic. but I have had enough of the topic for now.

  9. Draal says:

    This thread has so veered there’s no redeeming it and should be locked.
    That said, I’m going to ignore that and further go off topic.

    Making fun of the use of a reputable source is illogical. An legitimate, established dictionary is a much better source that say wikipedia. That being said, no one definition is 100% correct in every situation. It only matters that the person using the word is understood by the other person. Definitions change over time too. A word used 100 years ago is not guaranteed to mean the same thing today. In the context of this skeptical blog, I’d say the definitions of the logical fallacies being tossed around on this blog are explained here: http://www.theness.com/neurologicablog/?p=499.

    Generally, insults are not considered strictly logical fallacies, but it does reflect the level of civility of the person. However, here’s an example from a skeptic website that cites insults as being a logical fallacy, specifically an Abusive ad hominem. http://atheism.about.com/library/FAQs/skepticism/blfaq_fall_abusive.htm

  10. Draal says:

    K, here’s a pointless thought and question:
    In the 1940s, the flu vaccine was first developed. At the time, I’m assuming, it was believed that the vaccine would just work because of success with other vaccines. There were no clinical trials (probably used on military personal first) that proved their efficacy; in fact, they weren’t very effective.
    Say we were in the 1950s (and only in this case): On a strictly skeptical stand point, should a skeptic get a flu vaccine? Let’s assume we know that other vaccines work, we know the theory on how they should work, but there is no overwhelming evidence to support the use of the flu vaccine. keep in mind the bulk of the flu efficacy studies were performed in the 70s and 80s.
    Another way to look at it is… if skeptics ruled the world, should the flu vaccine not have been used until it was first proven safe and effective? Sure it’s been proven now but it was used for decades without the evidence we have now.

  11. weing says:

    That’s like asking if a skeptic should use a parachute? Please, we’ve been through that already. It may work, it may not, but it’s the best shot you’ve got. Anyway, that’s how I see it. The choice seems obvious to me, it may not be to you. Our backgrounds and understanding of the issues differ. Ask your doctor, and take or leave his advice. He might say you can’t get the shot. I don’t give flu shots to people who have egg allergies.

  12. Draal says:

    Please, it’s not the same thing as a parachute. You’ve avoided my question. Historically speaking, am I wrong that vaccines were used without the clinical evidence backing them up? Should they have been used with the knowledge at hand?

    I don’t know how many times I have to say that I’m not against the vaccine. I whole heartedly believe in the use of vaccines. I just like challenging some of the claims that are used to support certain arguments.

    It just tickles me that the arguments presented these days would have destroyed pro-vaxxer claims when the flu vaccine was first invented (in my opinion). It makes me grin at the irony.

    Another irony was the fact that doctors purposefully did not administer antivirals to pregnant women to avoid complications with the fetus. And we know know that was the wrong decision since an unexpected number of those women died. Now the recommendation is to get those antivirals administered ASAP.

  13. Draal says:

    Just to be crystal clear in what I said… arguments that support the use of vaccines today (efficacy, safety, so on and so forth), would have worked against those who were in favor of the flu vaccine in the 40s, 50s and 60s because that information on safety and efficacy was not present then. Hence, I would think a skeptic using today’s standards would have called shenanigans on the unsupported claims way back when.

  14. cheglabratjoe says:

    If you’re not anti-vaccine, what is the point of your question? Yes, before widespread testing was done, I suppose flu vaccines were used based on their safety, the stunning success of other vaccines, and the soundness of their mechanism of action. So the hell what? The same could be said of ANY preventative procedure.

    Are you also “tickled” by the fact that antivax-type arguments would’ve destroyed the pro-hand-washing claims when they were first proposed.

    Also, are you grinning at the second irony you mentioned (pregnant women dying due to mistaken concerns about their fetus), too? Yeah, that’s really freaking hilarious, pal.

  15. Dr Benway says:

    Draal, we are always reasoning from incomplete and imperfect information. We estimate the probabilities of competing hypotheses as best we can, then pick the causal explanation that seems most likely. We’re always learning more and our estimations are always changing. We seek to live gracefully with this constant uncertainty around us.

    Now some argue that because we don’t know a lot of things, making shit up to suit is fine. You like country; I like rock-n-roll. You like the mercury-causes-autism idea; I like the inflammation-causes-autism idea.

    No! There are rules. Here’s a biggie, it’s called “Bayes’ theorem”:

    P(H|O) = P(H) * P(O|H)/P(O)

    The probability of a hypothesis given an observation equals
    the prior probability of the hypothesis
    times the probability of the observation given the hypothesis
    divided by the prior probability of the observation.

    Note that confidence in the prior probability of H has a HUGE impact upon the equation above.

    To estimate prior probabilities, you need to understand all the science that surrounds an idea. n00bs have trouble sifting through the mountain of related facts for those most relevant to the problem at hand. I think it’s here that the pseudoscience mind gets stuck.

    With respect to vaccines, we’re lucky. We know a tremendous amount about antigen-antibody relationships. In a nutshell:

    1. Expose the body to certain antigens and it will make antibodies. Maybe not always as many as we’d like, but we can tweak that.

    2. The more individuals with antibodies to a pathogen, the smaller and weaker the disease outbreak.

    3. Because the body is swimming in foreign antigens all the time, the risk of exposing the body to a few more is hardly worth mentioning. Yes, one in a million people have a bad reaction to a vaccine. But one in a people have a bad reaction to perfume or carrots or incense or sushi or whatever.

    The epidemiological surveys confirm the above, even when the data are kinda noisy or otherwise kinda crappy.

    There are many therapies in medicine that rest upon a very sketchy understanding of how they work in the body. Vaccines aren’t one of those therapies.

  16. weing says:

    Historically speaking, am I wrong that vaccines were used without the clinical evidence backing them up?
    I don’t know. Could be. Clinical evidence had to be acquired somehow.

    Should they have been used with the knowledge at hand? You could test them if you have a plausible hypothesis. Whenever a new drug comes out. I first try it on the family pet. If it survives, I try it on the in-laws. If they survive, I can try it on myself. If I survive, then I can try it on my patients.

  17. Draal says:

    If you’re not anti-vaccine, what is the point of your question?

    Sorry for not drinking the kool-aid and believing everything that’s posted on this blog immediately. I’ll ask questions and not “parachute” before getting as much info.

    So the hell what? The same could be said of ANY preventative procedure.

    Uh, because cranks make that same claim. Have some homeopathic water or snake oil, it’s been said they prevent all your ails.

    Are you also “tickled” by the fact that antivax-type arguments would’ve destroyed the pro-hand-washing claims when they were first proposed.

    I’m in stitches.

    pregnant women dying due to mistaken concerns about their fetus…Yeah, that’s … hilarious

    You’re just sick. You need your head examined. Try not to make a straw man out of something I never said.

  18. Draal says:

    And one more thing cheglabratjoe, if you want to be ignorant of past mistakes, be my guest. I’d rather be aware of them to avoid them in the future.

    Those who cannot learn from history are doomed to repeat it. -George Santayana

  19. cheglabratjoe says:

    Did you read what I wrote, champ? You’re hardly worth responding to.

    Here’s what I said about vaccines: “Yes, before widespread testing was done, I suppose flu vaccines were used based on their safety, the stunning success of other vaccines, and the soundness of their mechanism of action.”

    Your response to that was: “[C]ranks make that same claim. Have some homeopathic water or snake oil, it’s been said they prevent all your ails.”

    Really? Homeopathic water has theoretical backing? Snake oil is safe? Past homeopathic remedies worked well? Your response is nonsense.

    As for me being the one who needs his head checked, I think thou doth protest too much. Could you really not tell that I was being sarcastic, or that *you* made it seem like pregnant women’s deaths were comically ironic?

  20. Dr Benway says:

    I have an hypothesis: When I post from locations that aren’t my home base, I get caught in the spam filter.

    Well I’m home now. And this post has no naughty words nor any linkies.

    Let’s see if we can reject the null hypothesis: “I will be spam canned just as I was earlier when I tried posting from the office.”

  21. Dr Benway says:

    Failed to reject the null. Ha!

    My science kicks ass.

  22. Dr Benway says:

    Durp. I mean, reject dat null sucka!

    My brain does oppositie stuff to me from time to time.

    I should fix a confusing sentence in the post way up there that someone nicely scooped from the trash:

    “Yes, one in a million people have a bad reaction to a vaccine. But one in a million people have a bad reaction to perfume or carrots or incense or sushi or whatever.”

  23. Peter Lipson says:

    I dug it outta the spam filter

  24. Dr Benway says:

    Why thank ye, Dr. Lipson.

    Say, you otta be in bed. Nurse Ratchet may require your assistance as to the meaning of “MOM prn no BM” prior to change of shift at 06:30.

  25. yeahsurewhatever says:

    I guess I missed the party.

    To clarify the matter on what’s an argumentum ad hominem, “you’re wrong because you’re ugly” is argumentum ad hominem, whereas “you’re wrong plus you’re ugly” is not. Pretty obvious distinction.

    There’s also the argumentum ad dictionarium, but wales seems to be very familiar with that.

    As for his claim that “doctors have a fiduciary obligation to individual patients”, I don’t think he quite understands what that fiduciary duty entails. He’d be hard-pressed to successfully argue in any court of law in the United States that a physician is breaking a fiduciary duty by giving you a flu shot. He’d also be hard-pressed to find an attorney willing to touch that claim, since it can easily be interpreted as frivolous and vexatious.

  26. Draal says:

    Watched 60 Minutes last night and there was a report on the H1N1 pandemic and interviews with the heads of the CDC.
    Two things I learned that I wanted to express and see if anyone else agrees.

    1. The secondary bacterial infections, bacterial pneumonia, is what is killing young adults. This is occurring b/c the “virus and flu” are damaging the lungs and make the lungs more susceptible to infection (like an open skin cut is susceptible to infection).
    — I figure the virus is killing cells in the lungs as it replicates, hence the damage, but I’m unclear how the flu itself damages the lungs. If anyone knows the answers, please inform me.

    2. The H1N1 is related to the 1918 Spanish Flu. Between 1930s-1950, there were other Spanish Flu related strains circulating in the general public. Anyone born before 1950, exposed to a Spanish Flu related virus, therefore has antibodies that are protecting them. Hence, older people born before 1950, are less likely to affected by the novel swine flu.

    Sounded very plausible. Can any one provide further support to the 60 Minutes claims?

  27. wales says:

    I go away for a few days and some of you are still jabbering about the meaning of ad hominem.

    It appears that the types of ad hominem are more varied and nuanced than the personal opinions so generously proffered here. The types are explored here (including the non-fallacious types).

    http://www.phaenex.uwindsor.ca/ojs/leddy/index.php/informal_logic/article/view/2475

    As the authors state “It is not at all easy to classify ad hominem arguments by sharp and unambiguous criteria.”

    Call it what you will, unscientific personal opinion attempting to generate suspicion of bias on the part of T. Jefferson based upon a cancelled speaking engagement is strange. Why? Such appeals to emotion in lieu of valid criticism of the science appear odd coming from self-declared science mavens in a supposed science based venue. They also appear to be no different than similar comments intended to generate suspicion of Paul Offit’s objectivity based upon his vaccine patent ownership and former ACIP membership. I note that such comments about Dr. Offit are always vigorously criticized here (and I daresay have been at times characterized as ad hominem attacks).

    When the S is missing from SBM all that’s left is BM.

  28. weing says:

    Draal,

    When cells die or undergo lysis, they release substances that evoke an inflammatory response. This consists of swelling, heat, redness, pain, and loss of function. Imagine this happening all over in the lining of your lungs.

  29. Draal says:

    Heard a new one I heard today from a coworker.

    She was told that “they” are recommending that Tylenol not be given to children before taking them to the doctor’s office to receive the flu shot. Tylenol serves to lessen the swelling and mild fever post-shot. Apparently, Tylenol suppresses the immune response and the immune response/number of anitbodies is lower as a result. Without the Tylenol, the kids are supposedly very cranky, sore and run a mild fever.

    http://www.kold.com/Global/story.asp?S=11326081

    Although fever is part of the normal inflammatory process after immunisation, prophylactic antipyretic drugs are sometimes recommended to allay concerns of high fever and febrile convulsion. We assessed the effect of prophylactic administration of paracetamol at vaccination on infant febrile reaction rates and vaccine responses. In two consecutive (primary and booster) randomised, controlled, open-label vaccination studies, 459 healthy infants were enrolled from ten centres in the Czech Republic. Infants were randomly assigned with a computer-generated randomisation list to receive three prophylactic paracetamol doses every 6-8 h in the first 24 h (n=226) or no prophylactic paracetamol (n=233) after each vaccination with a ten-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) co-administered with the hexavalent diphtheria-tetanus-3-component acellular pertussis-hepatitis B-inactivated poliovirus types 1, 2, and 3-H influenzae type b (DTPa-HBVIPV/ Hib) and oral human rotavirus vaccines. The primary objective in both studies was the reduction in febrile reactions of 38.0°C or greater in the total vaccinated cohort. The second objective was assessment of immunogenicity in the according-to-protocol cohort. These studies are registered with ClinicalTrials.gov, numbers NCT00370318 and NCT00496015. Fever greater than 39.5°C was uncommon in both groups (after primary: one of 226 participants [<1%] in prophylactic paracetamol group vs three of 233 [1%] in no prophylactic paracetamol group; after booster: three of 178 [2%] vs two of 172 [1%]). The percentage of children with temperature of 38°C or greater after at least one dose was significantly lower in the prophylactic paracetamol group (94/226 [42%] after primary vaccination and 64/178 [36%] after booster vaccination) than in the no prophylactic paracetamol group (154/233 [66%] after primary vaccination and 100/172 [58%] after booster vaccination). Antibody geometric mean concentrations (GMCs) were significantly lower in the prophylactic paracetamol group than in the no prophylactic paracetamol group after primary vaccination for all ten pneumococcal vaccine serotypes, protein D, antipolyribosyl-ribitol phosphate, antidiphtheria, antitetanus, and antipertactin. After boosting, lower antibody GMCs persisted in the prophylactic paracetamol group for antitetanus, protein D, and all pneumococcal serotypes apart from 19F. Although febrile reactions significantly decreased, prophylactic administration of antipyretic drugs at the time of vaccination should not be routinely recommended since antibody responses to several vaccine antigens were reduced.

    Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials
    Lancet, Volume 374, Issue 9698, Pages 1301-1392, Pages 1339-1350

  30. Pingback: H1N1 Talk « L S S
  31. Citizen Deux says:

    A great site with a point by point counter to the viral video from Sr. Teresa Forcades, MD PhD. Talk about using your credentials for the wrong purposes!

    English Translation

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